Healthcare Provider Details

I. General information

NPI: 1851397889
Provider Name (Legal Business Name): JANETTA C PROVERBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

9375 W 75TH ST
OVERLAND PARK KS
66204
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax: 360-514-1065
Mailing address:
  • Phone: 913-642-7000
  • Fax: 913-642-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0426209
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61042142
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: